1324. Post-Operative Dysphagia in Children Undergoing Resection for Posterior Fossa Tumors

Authors: Katie Stormes; Katie Stormes; Audrey Wassef; Nisha Gadgil, MD; Sandi Lam, MD (Houston, TX)

Introduction:

Posterior fossa tumors (PFTs) are the most common type of brain tumor diagnosed in children. Neurological deficit may ensue following posterior fossa craniotomy for resection of these tumors, including impaired swallowing or dysphagia.

Methods:

The medical charts of all children who had surgery for a posterior fossa tumor between April 2007 and May 2017 at a tertiary children’s hospital were analyzed. The primary analysis characterized tumor based on radiology, presenting symptoms, and general post-operative complications. From this cohort, patients who were diagnosed with dysphagia post-operatively were further examined.

Results:

There was a total of 197 patients who underwent surgery for posterior fossa tumor during the study period. The most common tumors were juvenile pilocytic astrocytoma and medulloblastoma. Most patients had hydrocephalus at presentation and required an emergent external ventricular drain (EVD) but approximately one-third required a shunt.

Post-operative Dysphagia

There were 43 (21.8%) patients who developed dysphagia after surgery. There were 34 patients who required tube feeding immediately post-operatively with 21(10.6% of the 197 patients) requiring long-term gastrostomy tube. Fourteen patients (7.1%) were permanently gastrostomy-dependent by their last known follow-up.

One-year follow-up of dysphagia

Of the patients diagnosed with post-operative dysphagia, 21 patients reported no swallowing impairment and had transitioned to a normal diet with no modifications by one-year follow-up. There were 10 patients who remained gastrostomy-dependent; 6 of these patients had a modified oral diet, and 4 patients had no oral intake.

Conclusion:

Post-operative complications such as swallowing impairment may cause significant morbidity following posterior fossa craniotomy for tumor in children and require further procedures and close follow up. One in 5 patients with post-operative dysphagia required supplemental feeding and 7.1% of patients required a permanent feeding tube.